department of regulatory agencies
Division of Registrations
3 CCR 716-1
CHAPTER XV
RULES AND REGULATIONS FOR PRESCRIPTIVE AUTHORITY
FOR ADVANCED PRACTICE NURSES
BASIS: The authority for the promulgation of these rules and regulations by the State Board of Nursing (“Board”) is set forth in Sections 12-38-108(1)(j) and 12-38-111.6 of the Colorado Revised Statutes (C.R.S.).
PURPOSE: Section 12-38-111.6(4.5), C.R.S. sets forth the legal requirements for an Advanced Practice Nurse (APN) to obtain prescriptive authority in Colorado. First, the APN must obtain Provisional Prescriptive Authority. Generally, those requirements are:
· Completion of a graduate degree in a nursing specialty
· Satisfactory completion of educational requirements as determined by the Board in the use of controlled substances and prescription drugs.
· National certification by a nationally recognized accrediting agency as determined by the Board in the Role/Specialty of the APN, unless the Board grants an exception;
· Professional liability insurance if required by Chapter XXI of the Board’s Rules and Regulations; and
· Completion of an 1800 hour Preceptorship with a Physician Preceptor or Physician Preceptor and RXN Preceptor.
Upon receiving Provisional Prescriptive Authority, the APN is legally authorized to prescribe medications to patients appropriate to the APN’s Role/Specialty and Population Focus. Within five years of receiving Provisional Prescriptive Authority the APN with prescriptive authority (hereinafter referred to as RXN-P) must:
· Complete an 1800 hour Mentorship with a Physician Mentor or Physician Mentor and RXN Mentor; and
· Develop an Articulated Plan for safe prescribing.
If the RXN-P does not complete these additional requirements within five years of receiving Provisional Prescriptive Authority such authority will expire for failure to comply with statutory requirements.
The purpose of these rules is to further clarify each of the statutory requirements, with the exception of professional liability insurance, which can be found in Chapter XXI of the Board’s Rules and Regulations. These rules apply only to the prescribing relationship and should not be construed to govern other relationships between APNs and health care providers in other situations.
1 DEFINITIONS
1.1 Accrediting Agency: An organization that establishes and maintains standards for professional nursing programs and recognizes those programs that meet these standards and is recognized by US Department of Education (USDE) and/or the Council for Higher Education Accreditation (CHEA), including the Commission on Collegiate Nursing Education (CCNE), National League for Nursing Accrediting Commission (NLNAC), Council on Accreditation of Nurse Anesthesia Educational Programs (COA), Accreditation Council for Midwifery Education of the American College of Nurse Midwives, and the National Association of Nurse Practitioners in Women’s Health Council on Accreditation.
1.2 Advanced Practice Nurse (APN): A professional nurse who meets the requirements of Section 12-38-111.5, C.R.S. and who obtained specialized education or training and is included on the Advanced Practice Registry.
1.3 Advanced Practice Registry (APR): The Board’s record of those professional nurses who are granted APN status by the Board in accordance with Section 12-38-111.5, C.R.S. and Chapter XIV of the Board’s Rules and Regulations.
1.4 Applicant: An APN seeking Provisional Prescriptive Authority in the same Role/Specialty and Population Focus for which the APN was recognized on the APR.
1.5 Articulated Plan: A written document that includes a strategy for safe prescribing and outlines how the RXN intends to maintain ongoing collaboration with physicians and other health care professionals in connection with the RXN’s practice of prescribing medications within the RXN’s Role/Specialty and Population Focus.
1.6 Board: The State Board of Nursing
1.7 Certifying Body: A non-governmental agency approved by the Board that validates by examination, based on pre-determined standards, an individual nurse’s qualifications and knowledge for practice in a defined functional or clinical area of nursing.
1.8 DEA: Drug Enforcement Administration
1.9 Disciplinary Sanction: Any current restriction, limitation, or condition on a Physician Preceptor’s or Physician Mentor’s medical license or on an RXN Preceptor’s or RXN Mentor’s nursing license, including confidential participation in a peer health assistance or an alternative to discipline program authorized by the mentor or preceptor’s licensing board.
1.10 Full Prescriptive Authority: The authority granted to the RXN to prescribe medications upon completion of the required Mentorship and development of an Articulated Plan in accordance with the Role/Specialty and Population Focus of the RXN. Prescribing with Full Prescriptive Authority will be in accordance with the RXN’s Articulated Plan.
1.11 Mentorship: A formal, Mutually Structured relationship between an RXN-P, as defined in Section 1.24 below, and a Physician Mentor or Physician Mentor and RXN Mentor to further the RXN-P’s knowledge, skill, and experience.
1.12 Mutually Structured: A written plan for a Preceptorship or a Mentorship that is developed and implemented together and agreed upon by all preceptors or mentors and the Applicant or RXN-P.
1.13 Pathophysiology: A minimum of three (3) semester hours or four (4) quarter hours completed at the graduate or post-graduate level in an accredited nursing program for which graduate credit has been awarded with an emphasis appropriate to the Role/Specialty and/or Population Focus of the APN, including but not limited to pathophysiologic processes of all body systems.
1.14 Pharmacology: A minimum of three (3) semester credit hours or four (4) quarter hours completed at the graduate or post-graduate level in an accredited nursing program for which graduate credit has been awarded with an emphasis appropriate to, but need not be identical to the Role/Specialty and Population Focus of the APN, including but not limited to the study of pharmacotherapeutics and pharmacokinetics of broad categories of pharmacological agents.
1.15 Physical Assessment: A minimum of three (3) semester hours or four (4) quarter hours completed at the graduate or post-graduate level in an accredited nursing program for which graduate credit has been awarded with an emphasis appropriate to the Role/Specialty and/or Population Focus of the APN, including but not limited to comprehensive history taking; physical and psychological assessment of signs and symptoms; pathophysiologic and psychopathologic status of the patient; and development of a clinical diagnosis and disease management.
1.16 Physician Mentor: A person who holds a license to practice medicine in Colorado or a physician who is otherwise exempted from licensure pursuant to Section 12-36-106, C.R.S. The physician’s license must be in good standing without Disciplinary Sanction as defined in Section 1.9 above. The Physician Mentor must be actively practicing medicine in the State of Colorado and shall have education, training, experience and a practice that corresponds with but need not be identical to the Role/Specialty and Population Focus of the RXN-P. The Physician Mentor must also have an unrestricted DEA registration for the same controlled substance schedules as the RXN-P being mentored.
1.17 Physician Preceptor: A person who holds a license to practice medicine in Colorado or a physician who is otherwise exempted from licensure pursuant to Section 12-36-106, C.R.S. The physician’s license must be in good standing without Disciplinary Sanction as defined in Section 1.9 above. The Physician Preceptor must be actively practicing medicine in the State of Colorado and shall have education, training, experience and a practice that corresponds with but need not be identical to the Role/Specialty and Population Focus of the Applicant. The Physician Preceptor must also have an unrestricted DEA registration.
1.18 Population Focus: A broad area of study encompassing the common problems of a specific group of patients and the likely co-morbidities, interventions and responses to those problems including, but not limited to, the following areas of practice: Family/individual across the life span; adult-gerontology; neonatal; pediatrics; women’s health/gender related; psych-mental health. A Population Focus is not defined as a specific disease, health problem or intervention.
1.19 Preceptorship: A Mutually Structured, individualized period of practical experience and training between an Applicant and a Physician Preceptor or Physician Preceptor and RXN Preceptor that does not require a set curriculum but is designed to further the Applicant’s knowledge, skill, and experience.
1.20 Prescription Order: Any order authorizing the dispensing of a single drug or device that is written, mechanically produced, computer generated and signed by a legally authorized prescriber, transmitted electronically or by facsimile, or produced by other means of communication to a licensed pharmacy or pharmacist and that includes the name or identification of the patient, the date, the symptom or purpose for which the drug is being prescribed, if included at the patient’s authorization, and sufficient information for compounding, dispensing and labeling.
1.21 Provisional Prescriptive Authority: The authority granted to the Applicant to prescribe medications upon completion of the required Preceptorship in accordance with the Role/Specialty and Population Focus of the RXN. Prescribing with Provisional Prescriptive Authority requires that a Mutually Structured Mentorship exist between the RXN-P and a Physician Mentor or Physician Mentor and RXN Mentor.
1.22 Role/Specialty: The advanced practice area or position for which the Applicant has been prepared including nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and/or clinical nurse specialist (CNS).
1.23 RXN: An APN who is listed on the APR and who has been granted Full Prescriptive Authority by the Board.
1.24 RXN Mentor: A professional nurse who has met the qualifications for an APN, is included on Colorado’s APR, has Full Prescriptive Authority in Colorado, and has experience prescribing medications. The RXN Mentor’s nursing license must be without Disciplinary Sanction as defined in Section 1.9 above. The RXN Mentor shall have an active practice in Colorado and shall have education, training, experience and a practice that corresponds with, but need not be identical to, the Role/Specialty and Population Focus of the RXN-P. The RXN Mentor must also have an unrestricted DEA registration for the same controlled substance schedules as the RXN-P.
1.25 RXN Preceptor: A professional nurse who has met the qualifications as an APN, is included on Colorado’s APR, has Full Prescriptive Authority in Colorado, and has experience prescribing medications. The RXN Preceptor’s nursing license must be without Disciplinary Sanction as defined in Section 1.9 above. The RXN Preceptor shall have an active practice in Colorado and shall have education, training, experience and a practice that corresponds with, but need not be identical to, the Role/Specialty and Population Focus of the Applicant.
1.26 RXN Provisional (RXN-P): An APN who is listed on the APR and who has been granted Provisional Prescriptive Authority by the Board.
1.27 Unencumbered: No current restriction to practice in the state of Colorado.
2 EDUCATIONAL REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY
2.1 An Applicant for prescriptive authority must have successfully completed a graduate degree or post-graduate nursing degree in the Role/Specialty and Population Focus for which the Applicant seeks prescriptive authority. Such coursework shall include a minimum of three (3) graduate semester hours or four (4) quarter hours in each of the following: Pathophysiology, Pharmacology and Physical Assessment. The coursework in Pharmacology shall include education on prescribing drugs and controlled substances.
2.2 The transcript shall verify date of course completion, grade and credits awarded. Applicants must provide copies of course descriptions or course syllabi when the required coursework in Physical Assessment, Pathophysiology, and Pharmacology is integrated into broad categories of advanced practice courses or when course titles do not accurately reflect course content.
2.2.1 Letters of verification are generally not accepted documentation for the educational requirements of Physical Assessment, Pathophysiology, and Pharmacology, however, the Applicant may petition the Board on a case-by-case basis for a waiver. The decision to grant or deny such waiver shall be at the sole discretion of the Board.
3 NATIONAL CERTIFICATION REQUIREMENT
3.1 Pursuant to Section 12-38-111.6 (4.5)(a)(III) C.R.S., a professional nurse applying for prescriptive authority must obtain and maintain national certification from a recognized Accrediting Agency in the corresponding Role/Specialty and Population Focus for which the APN is applying for prescriptive authority.
3.1.1 If the Applicant cannot meet the requirements above, the Applicant may petition the board for an exception. Exceptions will be reviewed on a case-by-case basis. The decision to grant or deny such exception shall be at the sole discretion of the Board.
3.2 Certification requirements for Certified Registered Nurse Anesthetist (CRNA): Certified Registered Nurse Anesthetist (CRNA) must pass the national certification examination as administered by the Council on Certification of Nurse Anesthetists. Documentation required shall be verification of current certification or recertification from the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists, as approved by the Board.
3.3 Certification Requirements for Certified Nurse-Midwife (CNM): A Certified Nurse-Midwife must meet the standards for education and certification established by the American College of Nurse-Midwives American Midwifery Certification Board (AMCB) formerly known as ACNM Certification Council (ACC, Inc.). Documentation required shall be verification of status as a current holder of an AMCB certificate.
4 PRECEPTORSHIP REQUIREMENTS
4.1 To obtain Provisional Prescriptive Authority, the Applicant must complete a Mutually Structured post-graduate Preceptorship of not less than 1800 hours. The Preceptorship must be completed within the five (5) year period immediately preceding the filing of the application for Provisional Prescriptive Authority. The Preceptorship shall be conducted with either a Physician Preceptor or a Physician Preceptor and RXN Preceptor [hereinafter referred to as preceptor(s)] as defined in Section 1.
4.2 The Preceptorship shall occur in a clinical setting that corresponds to the Applicant’s Role/Specialty and Population Focus and shall include, but not be limited to, precepted experience in pharmacological management; advanced Pharmacology; and precepted experience with specific drugs relevant to the Role/Specialty, Population Focus and scope of practice of the Applicant.
4.3 Interaction between the Applicant and the preceptor(s) shall occur at least weekly and more frequently if appropriate to provide for patient safety. If the Preceptorship is with a Physician Preceptor and RXN Preceptor, the Physician Preceptor must participate in a minimum of one (1) meeting per month.
4.4 During the Preceptorship all Prescription Orders must be signed or otherwise legally authorized by a preceptor or another person with full prescriptive authority.
4.5 The Applicant and all preceptor(s) shall provide documentation of completion of the Preceptorship as requested by the Applicant to complete the Board’s Provisional Prescriptive Authority application process. The preceptor(s) shall not, without good cause, withhold signature or otherwise fail to provide timely documentation of completion of the Preceptorship. Upon successful completion of the application process, the Applicant may be granted Provisional Prescriptive Authority.